My nightmare in the city of dreaming spires

Elyn Saks has built a career as a respected law professor despite battling all her life with the debilitating effects of schizophrenia. In this extract from her frank and moving memoir, she tells how the illness first struck when she was an American student alone in Oxford

Schizophrenia rolls in like a slow fog, becoming imperceptibly thicker as time goes on. At first, the day is bright enough, the sky is clear, the sunlight warms your shoulders. But soon, you notice a haze beginning to gather around you, and the air feels not quite so warm. After a while, the sun is a dim light bulb behind a heavy cloth. The horizon has vanished into a grey mist and you feel a thick dampness in your lungs as you stand, cold and wet, in the afternoon dark ...

Despite our common language, it's no secret that England and America are vastly different countries, with perhaps the biggest difference being the fabled British reserve. The sunny, open, Latin-tinged mores of Miami, combined with the Old South graciousness of Nashville's Vanderbilt University [where Saks studied as an undergraduate], seemed a world away in the far older and more courtly enclaves of Oxford. For example, cashiers never said: 'Y'all come back soon now!' or: 'Have a good day!' whenever we exchanged money for goods. I often left a shop, food or package tucked under my arm, wondering what I'd done wrong to be dismissed so coolly. Didn't it matter to them what kind of a day I had?

The weather turned cool, the sunlight dimmed a little, the days became shorter. Adding to my general disorientation was an educational system vastly different from the one in which I'd done my undergraduate work. Oxford's programme consists of optional, university-wide lectures and seminars, plus meeting alone with a tutor or supervisor once a week for an hour or less.

Exams come at the end of two or three years. For the weekly tutorial, a student reads a number of articles and then presents a paper, upon which the tutor then comments. I was accustomed to writing two or three long papers over a four-month period, not one short paper a week. I couldn't imagine being able to do it.

I made one new friend from America, a woman named Jean, who was studying in London; we met on a cigarette break in the bathroom at the British Embassy. Tall - as tall as I - and very thin and pretty, Jean had studied to be a nurse until she met her doctor-fiancé, Richard, who encouraged her to go back to school and finish her college degree.

She did well and ultimately won a Marshall scholarship to study linguistics at University College London. She was warm and approachable. I liked her and she seemed to like me, too. But she was in London and I was in Oxford; although we spoke by phone maybe once a week, she was an hour away.

From time to time, I got together with another woman in the dorms. She was from Canada and initially our friendship looked quite promising. But something was happening to me - something that had begun the summer before - that short-circuited our budding friendship: I was finding it difficult to speak. Literally, the words in my head would not come out of my mouth. Our dinner conversations grew increasingly one-sided and I was reduced almost totally to nodding in agreement, feigning a full mouth and trying to express whatever I was thinking with my face. The friendship trickled away.

And I couldn't speak on the phone with my family or friends in America, either; I'd decided that it cost too much, that it was therefore 'forbidden'. By whom, I couldn't have said; there just seemed to be some kind of vague but absolute rule against it. Of course, my family would have gladly paid the phone bill, but my distorted judgment told me I did not deserve to spend money on myself or to have others spend money on me.

Besides, nothing I had to say was worth hearing, or so said my mind. It's wrong to talk. Talking means you have something to say. I have nothing to say. I am nobody, a nothing. Talking takes up space and time. You don't deserve to talk. Keep quiet. Within weeks after my arrival in Oxford, almost everything I said came out in monosyllables.

As I grew steadily more isolated, I began to mutter and gesticulate to myself while walking down the street, something I had never done on my worst days at Vanderbilt or in Miami the summer before. When I heard the sounds I was making, I felt neither disturbed nor surprised; for some reason, it helped me feel calmer. It seemed to provide an arm's-length distance between me and the people who were walking past me. Oddly, it was soothing, much like clutching a well-worn blanket might have been to a frightened child. And so, with no reference point outside my head (friends, familiarity, being able to accomplish anything at school), I began to live entirely inside it.

And the vivid fantasies had followed me across the ocean. My doctor finds me huddled in a corner. He wants me to socialise with other people in the programme. I don't want to. They force me into a room where there are other people. I am supposed to talk to them. A man introduces himself: 'Hi, my name is Jonathan.' I do not respond. 'What's your name?' Again I do not respond. 'Are you a student here?' I mutter something to myself. My doctor comes over and encourages me to talk to this young man. I start screaming and run wildly about the room. Some of the attendants restrain me by force.

What was real, what was not? I couldn't decipher the difference and it was exhausting. I could not concentrate on my academic work. I could not understand what I was reading, nor was I able to follow the lectures. And I certainly couldn't write anything intelligible. So I would write something unintelligible, just to have a paper to hand to my tutor each time we met. Understandably, my tutor was flummoxed.

'This is not acceptable, Miss Saks,' he said. He was neither angry nor cold, but he was somewhat disbelieving. 'Surely you can agree?' he asked. 'Because, you see, the work here is hard to make any sense of.'

Dumbly, I nodded, sensing the hard wooden chair beneath and around me. I barely squeezed out a couple of syllables. 'Yes,' I said. 'Yes, I know.' I just didn't know what to do about it.

Jean, my London friend who'd been a nurse, sensed from our telephone conversations that something was going very wrong. I told her I was just having a hard time doing the required work, but evidently something else I said, or the way that I'd said it, let her know I was struggling with thoughts of wanting to hurt myself. During one phone call, Jean gently suggested that I talk to a doctor about seeing a psychiatrist.

'Oh, no,' I said, trying to force some levity into my voice. 'I'm not crazy or anything. I'm just kind of ... stuck.' Inside, another dialogue was going on: I am bad, not mad. Even if I were sick, which I'm not, I don't deserve to get help. I am unworthy.

A few weeks later, Jean's fiancé came to town. A neurologist, Richard was somewhat older than Jean and I and had an air of casual authority. He intrinsically seemed to understand that, for some people, it was harder to be a student than to be a professional working in the world. His presence was reassuring, not at all threatening; in fact, his looming height and excess poundage gave him the appearance of a large and generous teddy bear.

'Jean and I are very concerned about you,' he said quietly. 'We think you may be quite sick. Would you mind if I asked you some questions?'

'I'm not sick,' I responded. 'I'm just not smart enough. But questions, yes. Ask me questions.'

'Are you feeling down?'

'Yes.'

'Loss of pleasure in daily activities?'

'Yes.'

'Difficulty sleeping?'

'Yes.'

'Loss of appetite?'

'Yes.'

'How much weight have you lost in the last month?'

'About 15 pounds.'

'Do you feel like a bad person?'

'Yes.'

'Tell me about it.'

'Nothing to tell. I'm just a piece of shit.'

'Are you thinking of hurting yourself?'

I waited a moment before answering. 'Yes.'

Richard asked still more questions; I answered yes to each one. As dim as I was, it wasn't difficult to see the alarm on his face.

'You need to consult a psychiatrist right away,' he said in a measured tone. 'You need to be on antidepressant medicine. You're in danger, Elyn.' This was serious business, he explained. I couldn't afford to wait.

I thanked Richard and Jean for their concern and told them I would think about everything they'd said. But I was not persuaded. Pills? Something chemical to go into my body and muck about with it? No, that would be wrong. My father's voice: pull yourself together, Elyn. There could be no drugs - everything was all up to me. And me wasn't worth much. I'm not sick. I'm just a bad, defective, stupid and evil person. Maybe if I'd talk less, I wouldn't spread my evil around.

I needed to present another paper in my weekly seminar, but could not write. A feverish all-nighter produced three or four pages of pure drivel. Gobbledygook. Junk. Nevertheless, I read it aloud. Eyebrows rose. But there was no laughter, only silence. I had thoroughly humiliated myself in front of my Oxford colleagues. I have come to Oxford and I have failed. I am a bad person. I deserve to die.

I suddenly knew, as sure as I'd ever known anything in my life, that if I tried to kill myself, I would succeed. Richard's words came back to me and this time I really heard them: I was in danger. This was serious. I could die. And so many others - my parents, my brothers, my friends, the ones I'd allowed myself to actually care for - they would be badly hurt. However much pain I was in, however dimly attractive an ending to this might be, I could not bring that kind of pain to the people I loved and who loved me.

There was no time left to think or consider, or strategise my way out of this. I called Dr Johnson, a doctor I'd been assigned as my general practitioner when I first arrived, and urgently requested an appointment for that very day.

Once at Dr Johnson's office, I said I was feeling depressed. He asked me why and to my monosyllabic answers he reassured me that I could come and talk to him from time to time, as I felt the need. He'd no doubt seen his share of stressed-out students; perhaps I was simply another.

'I think I need to see a psychiatrist,' I said.

'I think I can help you, if you allow me,' he said. I hadn't slept in days, or bathed, or changed clothes - even I knew that I looked like hell, why couldn't he? Why wasn't he more alarmed? Couldn't he see? Didn't he know?

Dr Johnson started to ask the same questions Richard had asked. Was I sad? Had I lost pleasure in usually pleasurable things? How were my sleeping and eating? Even though my answers were as they had been to Richard's questions, Johnson didn't yet seem much concerned. And then he asked if I'd thought about hurting myself.

'Yes,' I said.

'Have you actually done anything?'

'Yes.' And I showed him a quarter-sized burn on my hand, which had come from deliberately touching an electric heater.

The expression on his face underwent a subtle change. 'What about killing yourself?' he asked. 'Have you thought about that as well?'

'Yes.'

He leaned in closer. 'How might you do that?' he asked.

'I have a full bottle of Inderal. A friend said it would kill me,' I said. Although I'd stopped taking the drug, which had been prescribed for anxiety, I'd never thrown it out. I'd also given some thought to touching the bars of the electric heater in my dorm room and electrocuting myself, I told him. 'Or maybe douse myself with gasoline, set myself on fire. That might be best, because I am bad and deserve to suffer.' Then I started muttering gibberish, something which I hadn't yet done in front of anyone I knew.

Dr Johnson asked me to wait outside for a few moments, then called me back into his office to say he had made an appointment for one o'clock that afternoon at the Warneford, the psychiatric division of Oxford's medical school.

'Will you be able to get there?' he asked.

'Yes.'

'Will you go?'

'Yes.' I was desperate. I held my own life in my hands and it was suddenly too heavy to be left there.

The days at the Warneford turned into a week, then a second week. I cancelled my appointments with my tutor, using what no doubt sounded like completely lame excuses (on the other hand, he was probably quite familiar with the sporadically unpredictable comings and goings of moody graduate students). There was no attendance taken at lectures, so my absence there went unremarked.

As for the work itself, I was convinced I would be able to keep up with my reading and somehow catch up. After all, this was temporary. This was like a bad cold or a bout of the flu. Something had gone wrong; it was simply a matter of finding out what that something was and fixing it.

I slept each night in my own bed, tried to read before shutting out the light, then rose the next day and trudged back to the Warneford. It was at this point, I think, that my life truly began to operate as though it were being lived on two trains, their tracks side by side. On one track, the train held the things of the 'real world' - my academic schedule and responsibilities, my books, my connection to my family (whom so far I'd managed to convince, on a series of blessedly brief, long-distance phone calls, that everything at Oxford was going just fine, thanks). On the other track: the increasingly confusing and even frightening inner workings of my mind. The struggle was to keep the trains parallel on their tracks and not have them suddenly and violently collide with each other.

Daily, my thoughts grew more disorganised. I'd start a sentence, then be unable to remember where I was going with it. I began to stammer severely, to the point where I could barely finish a thought. No one could stand to listen to me talk; some of the patients made fun of me.

Disengaged from my surroundings, I sat in the dayroom for hours at a time, jiggling my legs (I couldn't sit still, no matter how I tried), not noticing who came in or out, not speaking at all. I was convinced I was evil. Or maybe I was crazy - after all, I was sitting in a mental hospital, wasn't I? Evil, crazy; evil, crazy. Which was it? Or was it both?

One by one, each member of the staff tried to talk me into using antidepressant medication. Their recommendation surprised me. I thought they would encourage me to take something that would calm my body or organise my speech. Either way, anti-anxiety or antidepressant, I was adamant in my refusal. All mind-altering drugs are bad. I am weak, I simply need to get stronger, try a little harder and all will be well. Was that the sentient part of my mind speaking or the fractured part? I could not tell.

I spent most of one desperate weekend walking alone near the university, in a beautiful place called Christ Church Meadows. But the beauty of my surroundings made no impact on me at all; for all I knew, I could have been walking in a cave. I felt only desperation and a profound isolation that every day seemed to burrow more deeply into me. What a waste of oxygen it was for me to draw breath. Suddenly, the solution presented itself: killing myself. There it was again. And it seemed the best option. I'll douse myself with gasoline and light a match. A fitting end for a person as evil as I.

When I trudged back to the Warneford and reported to the staff what my weekend stroll had consisted of, they upped the ante. 'You need to come into the inpatient unit now, Elyn. You need to come in and stay in. You're in serious danger if you don't.' I didn't need much convincing. Terrified of what I might do if left to my own devices, I went back to my dormitory room, packed up my belongings and boarded the bus that would deliver me to a mental hospital.

I boarded the wrong bus. Confused about where I was, where I needed to go, and how exactly to get there, I finally arrived at the Warneford several hours late.

I had all the makings of an excellent mental patient.

· This is an edited extract from The Centre Cannot Hold by Elyn Saks, which is published by Virago on 13 September.

Beating the odds: Elyn's life

Elyn Saks grew up in Miami in the 1960s. Born in 1956 to loving, middle-class parents, she was an A-grade student, yet her happy childhood was marred by disquieting quirks. There were episodes of obsessive behaviour and night terrors and, occasionally, the physical world seemed to grow fuzzy. As a tall, geeky undergraduate at Nashville's Vanderbilt University, her grip on reality began to loosen. But her academic record remained spotless and she graduated as class valedictorian, going on to win a Marshall scholarship to study philosophy at Oxford. It was when she reached England that those early symptoms blossomed into a far graver illness, described in her autobiography, The Centre Cannot Hold.

Today, Elyn Saks is happily married with an impressive career - she is an endowed professor at the University of Southern California Gould School of Law, an adjunct professor of psychiatry at the University of California and a research clinical associate at the New Centre for Psychoanalysis in Los Angeles. She has also survived a stroke and battled cancer. 'For an unlucky person, I've been amazingly lucky,' she says. Along with medication, psychoanalysis and plenty of solitary time, she credits strong personal relationships and an active professional life with enabling her to keep her schizophrenia in check. More than once a day, she will still experience transient psychotic thoughts - 'but I'm usually able to say, "Oh, that's my illness" and distract myself'.

At 51, her biggest loss is not having become a mother; she is convinced she'd fall apart under the stress of parenthood. Until now, none but her doctors and a few close friends and family members has known about her schizophrenia.

'There are so many myths about the illness,' she says. 'Most people are too worried about the stigma to come out as schizophrenics, but until they do, there won't be role models for others.'